mjm

The doctors here are not 35 when they start working. Your calculations of school make 13 years on top of university. You see a large number of kids in their 20's working at hospitals here. So my point which seems extremely clear is that compared to their colleagues in the US for example, they get less time to learn and become knowledgeable. That is compounded by the fact that Japanese education at the higher levels does not come even moderately close to what is offered elsewhere in North America and parts of Europe. The kids studying here may spend X pr Y years in school, and the same can be said of any university student here. The quality of education, given the focus on learning in an almost apprentice-like manner once employed, gives rise to a large number of very narrowly skilled kids in the workplace. Now I know my knowledge base may be less than others but having had operations here, had my kids operated on, raising a child with Hydronephrosis, and working here for 27 years I guess I feel a little qualified in what I am saying

As for outcomes, are we really going to look at the stats like that? Any even passing familiarity with care here would tell you that although it is widely available at very low costs to everyone, it is also only provided to a certain extent. The outcomes of those who go into the hospital can be pretty grim given there is a very different approach to treatment and the extent to which it should be taken. Add to that the stats in most places include the entire society. Are we going to say that the US or the UK or anywhere else is accurately described thus? I for one have always had better care than an inner city poverty level resident so the stats are often less than useful for healthcare. A little like that wonderful benchmark of BMI. My own son's kidney disorder could not be diagnosed here but was in the US (using Japanese imaging machines no less!) His surgery here was conducted by a doctor who had trained in the US.

So on the cost of OTC meds as stated. 250 yen for 24 when yiou can get 500 tabs for approx. $6 in the US, makes the same quantity at the price of 250yen for 24 tabs approximately $47 at today's exchange rates. or looked at another way, 24 tabs in the US at those prices would be $0.32 or 8 times cheaper. So yes, "exorbitantly expensive".

evergrn

If you could expound on this, I'd be very interested to hear more. Do you mean that people who get admitted with heart failure or pneumonia or get diagnosed with advanced cancer will generally have poorer end-results in Jpn as opposed to the US in your opinion? Are you saying that workup/treatments are less aggressive, or that they don't like to exhaust as many options, in Jpn?

mrploddy

Yes there can be a lot of frustrations with the Japanese medical system.

I have a chronic illness due to having cancer - in the UK I can get a gel based solution but in Japan my only option is injections every 2 weeks.

Another example - I want to get my daughter vaccinated for meningitis - the vaccine doesn't exist in Japan for babies not to mention where we have a 6 i 1 vaccine in the UK it's split in to 3 or 4 injections in Japan.

The Japanese medical system is very weird in that sense. It's cheap and accessile and probably a lot less financially worrisome than the states.

One one hand primary care can be frustrating especially if you pick the wrong local clinic with a geriatric doctor who won't listen to you.

However on the flip side if you have an illness that requires technology or advanced surgery Japan has some of the most state of the art equipment available and in some instances available to certain patient groups at shockingly low prices.

You just have to approach it with the correct mindset - Japanese just do what their doctor says and take everything at face value - learn to know when to speak out and when to go with the flow.

Loren Pechtel

Japan also seems to have some sort of obsession with anything beyond the most mild of stimulants.

mjm

See that is the tough question to answer. Some in the US have phenomenal access and others near zero. My folks have very good access and I do too. That said here in Japan I have good access as well. The access here I have is due to our insurance plan and that will always still just be access that is a function of the perceived need to treat excessively or not. The best access here is always less than the best access in the US due to approach. Maybe it is pride that doctors in the US have that dives them and group-think here that drives them. I just do not know. But having seen it now in the cases of several friends who have been allowed to die, some with crazy good access in fact, having seen the treatment of my son and then later myself, I am inclined to describe it as a style that is based on limited resources needing to be shared as fairly as possible. That is enough to save many, not enough to save others.

Here you go to a clinic or hospital convenient to you for most every ailment from a cold to a bout of diverticulitis. You do not see the same doctor as you might in the US. That leads to a distance between patient and doctor that can perhaps be good for the doctor's impartiality but not so much for comforting the patient.

Advanced cancer is something you really do not want here as there appears to be a perception that you are on the way out anyway so they move faster towards palliative care than sticking with treatment to cure. Although there has been great change in recent years, there is still a major tendency not to advise the patient wholly, but instead let relatives decided how much they will be told. My thoughts on that are it is pretty hard to use your willpower to heal if you do not know what to focus the healing energy on in the first place. Perhaps this sty;e is die to the incredible longevity that can be expected here if you do not get sick. Maybe it is just a culling of the herd. I really do not know. I just am very glad each day I am healthy and vital.

evergrn

Very interesting insight. For someone who's contemplating a move back to Jpn down the road, this is definitely disconcerting. I want a healthcare system that will go all out to exhaust all options toward the goal of a cure if that is what the patient wishes. I presume that almost all of the latest and greatest cancer treatment options available in US are also available to some extent in Jpn. So then does Jpn have a system that makes them less readily available, and is that a resource thing vs philosophy thing? Who knows? Anyways, your comments definitely add a bit to my worries about moving there.

I only know Japanese healthcare through the experiences of my parents (whose issues are primarily orthopedic) and my sibling and friends (who're healthy). When my father dealt with extruded disc, I was impressed by how early and easily he got the MRI (although early MRI is not necessarily a good thing in all circumstances) and that he was prescribed Lyrica right from the get-go (in US, most insurances will balk at approving Lyrica for off label use, and most types of nerve are off label). My mother has gotten MRI's for different things in timely fashion, as well. But thankfully my folks are otherwise healthy, and we have not had to see them deal with the realm of Japanese medicine where you highlight issues. I do have to say, though, that it seems Japanese doctors do not like to hear suggestions/queries from pts. In the past, I've told my parents to ask their Japanese docs about this and that, and most of the time they were apparently brushed aside.

JamesBigglesworth

What? Are you assuming that everywhere else does the same as the US and requires an undergrad degree before starting medical school? In most countries you do 1 year of (to use a US equivilent term) "pre-med" and then, if accepted, go straight into your medical programme. You'll graduate at ~24 years old and then have 2-3 year residency.

US pre-med programmes are simply a way to raise barriers to entry.



Your conclusion doesn't follow from the premise. They study for about the same length of time. It's modeled after the German system, as a side note.



I'm sorry, but that doesn't follow either. All I'm doing is stating the facts.


Yes.

And we can do so because the OECD measures these things on a standardized basis for the express reason of being able to compare.

The reality is that average health care outcome is better in Japan than in the US. That obviously is only part of the picture and "average" is only that.




Very true. They only cover certain things. How is that different from the US?

Insurers only cover certain things in the US, and if you don't have insurance then you're fresh out of luck entirely.



Well, actually, you're more likely to suffer a medical mishap or secondary infection in the US hospital than you are a Japanese hospital. You are correct that treatment in Japanese hospitals does not extend as far as many US hospitals (if you have the insurance for it) but that is a current debate in medicine these days: is treatment adding to the quality of life for the patient? There's considerable research evidence that in the US, where treatment is continued far longer than anywhere else, it isn't. But the doctors and hospitals sure do make a lot of money from it...




I don't understand what you mean there. Can you elaborate, please?



But you're not in the US earning a US salary, are you?

JamesBigglesworth

The system itself in Japan recognizes the laws of diminishing returns and sets a limit on treatment via budget. The US is the exact opposite in that doctors are incentivized to extend treatment as long as possible because "someone else will pay the bill."

That said, if you want supplemental insurance that extends past what the NHI will cover then it's available.

mjm

Oh the horror. A barrier to entry to s profession of which the practitioners hold the lives of others in their hands. But if one is inclined to criticize it, oh please do definitely go somewhere with an easier route to a medical license.

It does in fact it is emphasized by the added point about barriers to entry. As for German medicine that is an entirely different story. When I graduated from Uni there it was very different than today I am sure.


A single stats course will point out the fallacy of this statement. Let's not pretend country population averages mean much in describing a comparable. The reality is stats can describe anything if viewed the right way. Utter nonsense. But if stats tell a person to seek treatment in Japan rather than in the US, they should by all means avail themselves of it.

It seems little knowledge is a dangerous thing (to paraphrase.)

If one defines death as better than life i can see where this would make sense. I stand on the opposite side of that position however.

A study of the usefulness of some statistics for purposes of defining certain things would clear up any confusion about that comment. Or we can just quote them and assume accuracy. Wait, no I think I will look at how they are derived before assuming accuracy.


I shop internationally. It's a funny old world these days that allows that. :-)

So you are American and have lived and been treated in that system for half a century? Or perhaps you live, work, and raise children in Japan, having done so for 25+ years? You see, I qualify on both counts.

If the above does not apply I am thinking the rhetoric is getting awfully troll-like.

mjm

So very incorrect. Misleading people with such statements is not so good.

gbs1112

An interesting debate. Japan v US regarding health care.
One statistic not yet introduced. Life expectancy in Japan is greater than US so they must be doing something right. Only fair to admit that the US figure is dragged right down by a huge underprivileged sector with poorer expectations from infancy onwards.

mjm

With a largely homogeneous society of East Asian descent compared to a mixed race society as in the US, added to which is a vastly different diet and mobility standard, the picture starts to clarify. Nothing to do with hospitalization, but with what genes the populations have and lifestyles prior to old age. If there were a medical solution to longevity it is a good bet it would be widely advertised.

gbs1112

Absolutely. Japan's public health programme is largely responsible. Their kids get off to a great start and it keeps going. Smoking is their next challenge but that programme is underway too. Money on public health and their overall health care system produces the results they have planned for.

mjm

It sounds as though this is describing calculated longevity. When the term public health program is used what specifically is meant? Certainly the coveralll health care is lacking so I am curious how this is being viewed.

I think a general mobility, attention to food consumed, a far less selfish and sedentary lifestyle than in the US contributes positively but I am curious about the poster's thoughts.

gbs1112

We are comparing apples and pears in this discussion.
Life expectancy is a good measure of the health of a nation.
Public health, sometimes called Preventitive Medicine, is Japan' s strength and is applied fairly evenly across the nation.
The US on the other hand excels in the management of illness. This has no significant effect on national life expectancy nor is it applied evenly.